Provider Demographics
NPI:1891517769
Name:BURRIS, CATHERINE BRADLEY
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:BRADLEY
Last Name:BURRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N CEDAR ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6454
Mailing Address - Country:US
Mailing Address - Phone:843-220-9672
Mailing Address - Fax:843-808-6830
Practice Address - Street 1:208 N CEDAR ST STE 202
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6454
Practice Address - Country:US
Practice Address - Phone:843-220-9672
Practice Address - Fax:843-808-6830
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health